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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0020" class="elsevierStylePara elsevierViewall">Las enfermedades cardiovasculares &#40;ECV&#41; son la principal causa de mortalidad en el mundo occidental<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; En Espa&#241;a&#44; la mortalidad por ECV representa el 28&#37; del total de defunciones en varones &#40;segunda causa de mortalidad&#41; y el 36&#37; en mujeres &#40;primera causa de mortalidad&#41;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; La prevalencia de ECV aumenta con la edad<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; y el aumento de la esperanza de vida incrementar&#225; esta proporci&#243;n&#46; En los &#250;ltimos a&#241;os se han promovido campa&#241;as y registros espec&#237;ficos para evaluar las diferencias por g&#233;nero en la frecuencia de ECV&#46; La mujer tiene un perfil de riesgo m&#225;s desfavorable que el var&#243;n&#44; con un uso sub&#243;ptimo de tratamientos farmacol&#243;gicos&#44; pruebas diagn&#243;sticas o medidas intervencionistas<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Las gu&#237;as cl&#237;nicas enfatizan medidas de prevenci&#243;n en el paciente con ECV<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a>&#46; Estos estudios se han efectuado mayoritariamente en la poblaci&#243;n masculina&#44; existiendo pocos ensayos que permitan extrapolar los resultados de forma inequ&#237;voca a la poblaci&#243;n femenina<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10</span></a>&#46; Existen registros nacionales e internacionales sobre el tratamiento y control de los hipertensos con y sin ECV&#44; que incluyen datos para varones y mujeres<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a>&#46; Algunos estudios que utilizan muestreo tienen como objetivo estudiar las diferencias por g&#233;nero<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#59; otras publicaciones aportan datos sobre la prevalencia general<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;20</span></a>&#46; A diferencia de estos estudios&#44; en este trabajo hemos examinado todos los pacientes hipertensos con y sin enfermedad cardiovascular para valorar la ECV que presentan&#44; el tratamiento y el cumplimiento de objetivos terap&#233;uticos en varones y mujeres atendidos en Atenci&#243;n Primaria&#46; La informaci&#243;n obtenida puede ayudar a establecer diferentes estrategias que mejoren el perfil cardiovascular en los hombres y en las mujeres&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Metodolog&#237;a</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Fuente de datos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio transversal a partir de registros informatizados de pacientes hipertensos de ambos sexos&#44; adscritos al &#193;rea Sanitaria 6 de Madrid&#46; Esta &#225;rea tiene una poblaci&#243;n de 661&#46;611 habitantes&#44; de nivel sociocultural medio-alto&#44; &#225;mbito residencial y poblaci&#243;n urbana &#40;el 17&#44;8&#37; de la poblaci&#243;n fue atendida por 7 equipos&#41;&#44; semiurbana &#40;el 46&#44;2&#37; de la poblaci&#243;n fue atendida por 9 equipos&#41; y rural &#40;el 36&#37; del total fue atendida por 9 equipos&#41;&#44; con el 15&#37; de los pacientes mayores de 65 a&#241;os&#46; Los 25 equipos de Atenci&#243;n Primaria de esta &#225;rea son atendidos por 308 m&#233;dicos&#46; Se incluyeron pacientes diagnosticados de hipertensi&#243;n arterial &#40;HTA&#41; en tratamiento farmacol&#243;gico y que hubieran acudido a sus centros de salud en el a&#241;o 2008&#44; para revisi&#243;n y solicitar prescripciones de f&#225;rmacos antihipertensivos&#46; Se consider&#243; ECV la presencia en la historia cl&#237;nica de los diagn&#243;sticos basados en la clasificaci&#243;n internacional en Atenci&#243;n Primaria versi&#243;n 2 &#40;CIAP-2&#44; aparato circulatorio&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> y que habitualmente proceden de informes de alta procedentes de atenci&#243;n hospitalaria&#58; cardiopat&#237;a isqu&#233;mica &#40;CI&#41; &#40;K74&#44; K76&#41;&#59; insuficiencia card&#237;aca &#40;IC&#41; &#40;K77&#41;&#59; enfermedad arterial perif&#233;rica &#40;EAP&#41; &#40;K99&#41;&#59; insuficiencia renal cr&#243;nica &#40;IRC&#41; &#40;U99&#41;&#59; ictus &#40;K89&#44; K90&#41; y fibrilaci&#243;n auricular &#40;FA&#41; &#40;K78&#41;&#46; Se consider&#243; que un paciente ten&#237;a HTA &#40;K85&#44; K86&#44; K87&#41; cuando constaba este diagn&#243;stico previo en la historia cl&#237;nica&#44; o bien figuraban tres tomas de presi&#243;n arterial &#40;PA&#41; en consulta &#8805; 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg en tres d&#237;as diferentes&#44; 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que es el mayoritariamente usado en Atenci&#243;n Primaria de las diferentes comunidades aut&#243;nomas de Espa&#241;a&#46; Se seleccionaron las variables&#58; edad&#44; sexo&#44; h&#225;bito tab&#225;quico&#44; cifras de presi&#243;n arterial sist&#243;lica y diast&#243;lica &#40;mmHg&#41;&#44; peso &#40;kg&#41;&#44; talla &#40;cm&#41;&#44; &#237;ndice de masa corporal &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; glucosa basal &#40;mg&#47;dL&#41;&#44; colesterol total &#40;mg&#47;dL&#41;&#44; LDL-colesterol &#40;mg&#47;dL&#41;&#44; HDL-colesterol &#40;mg&#47;dL&#41;&#44; triglic&#233;ridos &#40;mg&#47;dL&#41; y creatinina &#40;mg&#47;dL&#41;&#46; Se calcul&#243; el filtrado glomerular estimado &#40;ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41; con la f&#243;rmula MDRD<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Las variables anal&#237;ticas de laboratorio se obtuvieron mayoritariamente en los centros de salud en condiciones basales tras ayuno nocturno de 8 horas y fueron remitidas a los dos laboratorios de referencia del &#225;rea&#46; La morbilidad analizada se bas&#243; en la presencia de diagn&#243;sticos previos en la historia cl&#237;nica seg&#250;n c&#243;digos CIAP-2 para diabetes &#40;T90&#41; que considera los criterios de glucosa al azar &#62; 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL con s&#237;ntomas cl&#225;sicos de diabetes&#44; dos o m&#225;s glucemias al azar &#62; 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dL y dos o m&#225;s glucemias &#62; 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL a las dos horas de la sobrecarga oral con 75 g de glucosa&#59; hiperlipemia &#40;T93&#41;&#58; colesterol total en dos determinaciones &#62; 250<span class="elsevierStyleHsp" style=""></span>mg&#47;dL o &#62; 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL si hay diabetes&#44; enfermedad cardiovascular o riesgo cardiovascular elevado &#40;score &#62; 5&#41;&#59; obesidad &#40;T82&#41;&#58; &#237;ndice de masa corporal es &#62; 30 kg&#47;m<span class="elsevierStyleSup">2</span>&#59; 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anticoagulantes y antiagregantes &#40;B01&#41; e hipoglucemiantes &#40;A10&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis de datos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se revisaron los datos y se comprobaron las distribuciones de frecuencia y posibles errores de codificaci&#243;n&#46; Se comprob&#243; la normalidad de las variables con la prueba de Kolmogorov-Smirnov&#44; y se usaron estad&#237;sticos b&#225;sicos de centralizaci&#243;n&#44; media aritm&#233;tica y desviaci&#243;n est&#225;ndar &#40;DE&#41; en las variables continuas y distribuci&#243;n de frecuencias relativas &#40;prevalencia&#41; en las variables categ&#243;ricas&#44; con sus intervalos de confianza al 95&#37; &#40;IC 95&#37;&#41;&#46; Para las comparaciones de medias se us&#243; la prueba de la <span class="elsevierStyleItalic">t</span> de Student-Fisher en caso de variables independientes binarias y para comparaciones de proporciones se us&#243; la prueba de la Chi-cuadrado&#46; Se consider&#243; significaci&#243;n estad&#237;stica&#44; los valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Para todos los an&#225;lisis se utiliz&#243; el programa estad&#237;stico SPSS 15&#46;0&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">De un total de 96&#46;528&#44; se incluyeron 92&#46;079 historias&#46; El nivel de registro&#44; seg&#250;n las diferentes variables y grupos analizados&#44; oscil&#243; entre el 95&#37; para la variable tabaco&#44; y el 75&#37; para las variables PA&#44; peso y talla&#44; y del 60&#37; para las variables de laboratorio&#46; Se desestim&#243; el an&#225;lisis de la microalbuminuria por no existir un nivel adecuado de registro&#46; De las 92&#46;079 historias con HTA&#44; 19&#46;501 ten&#237;an un diagn&#243;stico previo de ECV &#40;21&#44;2&#37;&#59; el 23&#44;9&#37; en varones y el 19&#44;1&#37; en mujeres&#41; y 72&#46;578 padec&#237;an HTA&#44; pero no ten&#237;an un diagn&#243;stico previo de ECV &#40;78&#44;8&#37;&#41;&#46; Las caracter&#237;sticas generales y el an&#225;lisis comparativo de los pacientes con y sin ECV se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La distribuci&#243;n de factores de riesgo y morbilidad asociada fue mayor en los enfermos con ECV&#44; salvo la obesidad&#44; que se distribuy&#243; igual en ambos grupos&#46; La prescripci&#243;n de f&#225;rmacos antihipertensivos&#44; hipolipemiantes y antiagregantes fue significativamente mayor en el grupo con ECV &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; El control de presi&#243;n arterial y l&#237;pidos fue mejor en los pacientes con ECV &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas generales de los pacientes con ECV y el an&#225;lisis comparativo por g&#233;nero se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Del total de 19&#46;501 pacientes con ECV&#44; el porcentaje de varones fue similar al de mujeres &#40;49&#44;7 vs 50&#44;3&#37;&#41;&#46; La edad de las mujeres fue mayor &#40;78&#44;2 vs 71 a&#241;os&#41;&#46; El filtrado glomerular fue menor en mujeres&#44; con 35&#37; de mujeres con tasas &#60; 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span> frente a 25&#44;7&#37; de varones &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; El porcentaje de pacientes con presi&#243;n arterial &#60; 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; fue 59&#44;9&#37; &#40;IC 95&#37;&#58; 59&#44;2-60&#44;6&#41;&#44; siendo algo mayor en varones &#40;60&#44;5 vs 59&#44;1&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;08&#41; y el que ten&#237;a niveles de LDL-col &#60; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl fue del 36&#37; &#40;IC 95&#37;&#58; 35&#44;3-36&#44;7&#41;&#44; siendo significativamente mayor en varones &#40;40&#44;4 vs 31&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se recoge la distribuci&#243;n por g&#233;nero de los diferentes diagn&#243;sticos de ECV&#46; Encontramos diferencias estad&#237;sticamente significativas en la distribuci&#243;n de estas enfermedades&#44; siendo la cardiopat&#237;a isqu&#233;mica&#44; la enfermedad arterial perif&#233;rica y la insuficiencia renal cr&#243;nica m&#225;s frecuentes en los varones y la insuficiencia card&#237;aca&#44; la fibrilaci&#243;n auricular y el ictus m&#225;s frecuentes en las mujeres &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se presentan las tasas globales y especificas por g&#233;nero y edad &#40;&#8805; 65 y<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os&#41; y sexo de los diagn&#243;sticos de las diferentes ECV en los hipertensos estudiados&#46; Todas las ECV fueron m&#225;s prevalentes en los varones de ambos grupos de edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Fueron especialmente apreciables las diferencias en cardiopat&#237;a isqu&#233;mica e insuficiencia renal cr&#243;nica&#44; siendo pr&#225;cticamente el doble en varones que en mujeres&#44; tanto mayores como menores de 65 a&#241;os&#46; La prevalencia de fibrilaci&#243;n auricular e ictus fue mayor en varones que en mujeres menores de 65 a&#241;os &#40;2&#44;1 vs 1&#44;4&#37; para la fibrilaci&#243;n y 2&#44;4 vs 1&#44;3&#37; para ictus&#41;&#44; acort&#225;ndose&#44; en t&#233;rminos relativos&#44; estas diferencias en el grupo mayor de 65 a&#241;os &#40;10&#44;3 vs 9&#44;4&#37; para fibrilaci&#243;n auricular y 8&#44;6 vs 7&#44;1&#37; para ictus&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Los resultados del an&#225;lisis comparativo de consumo farmacol&#243;gico por g&#233;nero se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#46; Se encontr&#243; un consumo mayor de diur&#233;ticos &#40;52 vs 35&#44;3&#37;&#41; en mujeres &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; El uso de antiagregantes&#47;anticoagulantes &#40;68&#44;7 vs 63&#37;&#41;&#44; betabloqueantes &#40;40 vs 26&#37;&#41;&#44; antagonistas del calcio &#40;29 vs 26&#44;8&#37;&#41;&#44; inhibidores del sistema renina angiotensina aldosterona &#40;64 vs 61&#44;5&#37;&#41; e hipolipemiantes &#40;48 vs 36&#37;&#41; fue mayor en varones &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; De entre los pacientes que tomaban antiagregantes&#47;anticoagulantes&#44; se encontr&#243; mayor consumo de anticoagulantes orales en mujeres &#40;36 vs 29&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Este estudio realizado a partir de casi 100&#46;000 historias cl&#237;nicas de pacientes con HTA atendidos en el &#225;mbito de la Atenci&#243;n Primaria aporta un an&#225;lisis comparativo de los enfermos que padecen o no alguna ECV &#40;prevenci&#243;n primaria y secundaria&#41; y un an&#225;lisis de diferencias por g&#233;nero en los pacientes con eventos&#46; En general&#44; los enfermos con ECV presentan una mayor edad&#44; morbilidad y tratamiento farmacol&#243;gico y mejor control de presi&#243;n arterial y l&#237;pidos en el grupo con ECV&#46; Entre los pacientes con ECV encontramos diferencias de g&#233;nero&#44; tanto cualitativas como cuantitativas&#44; con respecto a la prevalencia de las ECV&#44; prescripci&#243;n farmacol&#243;gica y objetivos terap&#233;uticos alcanzados&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Al analizar las ECV observamos que la prevalencia de IC fue del 3&#44;3&#37;&#44; claramente inferior a la de estudios previos en Espa&#241;a &#40;alrededor del 19&#37; en el estudio HICAP en poblaci&#243;n hipertensa&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Esta diferencia sugiere un infradiagn&#243;stico importante&#44; tal vez porque en Atenci&#243;n Primaria no se emplean de forma sistem&#225;tica los criterios de Framingham<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; De igual forma&#44; en la EAP encontramos prevalencias muy inferiores a las reportadas por otros estudios<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> y a&#250;n menores si las comparamos con prevalencias de EAP asintom&#225;tica del estudio MERITO II &#40;30 al 50&#37; en pacientes con ECV&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Este hecho sugiere&#44; que en la pr&#225;ctica cl&#237;nica solo se est&#225;n identificando a los pacientes m&#225;s graves que requieren tratamientos m&#225;s agresivos u hospitalizaciones&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En cuanto a la cardiopat&#237;a isqu&#233;mica&#44; encontramos una prevalencia del 7&#44;5&#37;&#44; concordante con estudios previos&#44; tanto en poblaci&#243;n general como hipertensa<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;29</span></a>&#46; La prevalencia de FA ofreci&#243; datos similares a otros estudios como el PREVICTUS&#44; &#40;8&#44;5&#37; en poblaci&#243;n &#62; 60 a&#241;os&#44; de base poblacional&#41; o como los estudios analizados por P&#233;rez-Villacast&#237;n que reportan prevalencias entre el 2&#44;5 y el 17&#44;6&#37; seg&#250;n el entorno analizado<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a>&#46; Tambi&#233;n el ictus mostr&#243; prevalencias similares a otros estudios previos tanto en poblaci&#243;n general como en sujetos con HTA<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;32</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En cuanto a la prescripci&#243;n farmacol&#243;gica&#44; observamos una relativamente baja prescripci&#243;n de f&#225;rmacos con evidencia probada en prevenci&#243;n secundaria &#40;antiagregantes&#44; hipolipemiantes e inhibidores del sistema renina angiotensina aldosterona&#41;&#44; con diferencias de g&#233;nero considerables&#46; Se prescriben m&#225;s estatinas&#44; betabloqueantes&#44; inhibidores del sistema renina angiotensina aldosterona y antiagregantes en los hombres&#44; mientras que las mujeres reciben m&#225;s diur&#233;ticos&#44; antagonistas de los receptores de la angiotensina y anticoagulantes orales&#46; Destaca la mayor prescripci&#243;n de antagonistas de los receptores de la angiotensina solos o en combinaci&#243;n en mujeres&#44; lo cual pudiera deberse a la mayor prevalencia de tos que presentan las mujeres con inhibidores del sistema renina angiotensina aldosterona<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; Estos resultados son similares a los del suban&#225;lisis del estudio PRESENAP que analiza las diferencias de g&#233;nero de estas terapias en pacientes con cardiopat&#237;a isqu&#233;mica<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El control de la PA result&#243; similar al hallado en estudios previos de prevenci&#243;n secundaria<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#44; pero superior al comunicado en sujetos con HTA esencial &#40;41&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46; Es posible que el porcentaje de control de la PA sea incluso algo mejor&#59; al analizar tan solo las cifras de PA en consulta es posible que hayamos infraestimando el nivel de control de la PA por el efecto de bata blanca que tiende a elevar las cifras de PA en consulta<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#46; Las cifras del control de l&#237;pidos &#40;36&#37;&#41; son algo superiores a las comunicadas en estudios de prevenci&#243;n secundaria en nuestro entorno &#40;26&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> y tambi&#233;n resultaron significativamente mayores en varones<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Como todos los estudios transversales y de registros&#44; el presente trabajo tiene las limitaciones propias de los mismos&#58; imposibilidad de establecer relaciones de causalidad&#46; Otros estudios han utilizado muestras de m&#233;dicos o de pacientes que acuden a consulta aleatoriamente&#46; Nosotros hemos analizado a toda la poblaci&#243;n&#44; lo que refleja mejor la realidad de la pr&#225;ctica cl&#237;nica en un &#225;rea de salud concreta&#46; Hemos incluido solamente a pacientes en tratamiento farmacol&#243;gico&#44; que no representa a toda la poblaci&#243;n hipertensa&#44; porque es previsible que este grupo tendr&#237;a una mayor calidad de registros&#46; Con respecto a la codificaci&#243;n diagn&#243;stica &#233;sta se realiza de acuerdo a una clasificaci&#243;n internacionalmente aceptada y los diagn&#243;sticos estaban habitualmente documentados por informes de ingresos hospitalarios o pruebas complementarias&#44; pero puede haberse incurrido en alg&#250;n sesgo al analizar pacientes que no han precisado ingresos&#46; Este hecho ha podido afectar especialmente a las caracter&#237;sticas de la insuficiencia renal&#44; enfermedad arterial perif&#233;rica y a la ICC en sus formas menos sintom&#225;ticas&#46; Ser&#237;a deseable que de forma institucional se promoviera la homogeneizaci&#243;n de registros inform&#225;ticos para realizar an&#225;lisis como el aqu&#237; recogido y que permitiera comparar y monitorizar resultados en el tiempo de forma global&#44; obviando as&#237; los estudios por muestreo&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el presente estudio muestra una fotograf&#237;a exhaustiva y bastante n&#237;tida de la ECV en los pacientes con HTA atendidos en el &#225;mbito de la Atenci&#243;n Primaria&#46; La ECV afecta a los hombres a una edad m&#225;s temprana y presenta m&#225;s carga de morbilidad y factores de riesgo&#44; y los objetivos terape&#250;ticos obtenidos distan mucho de alcanzar los est&#225;ndares deseables<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#8211;40</span></a><span class="elsevierStyleSup">&#46;</span> Estudios posteriores por subgrupos de las afecciones analizadas pueden ayudarnos a identificar factores asociados a la ECV susceptible de tratamiento y consecuci&#243;n de objetivos terap&#233;uticos en la pr&#225;ctica cl&#237;nica&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0110" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            1 => "Enfermedad cardiovascular"
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            0 => "Arterial hypertension"
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            2 => "Prevalence"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar las caracter&#237;sticas de la enfermedad cardiovascular &#40;ECV&#41;&#44; el tratamiento y cumplimiento de los objetivos terap&#233;uticos para la presi&#243;n arterial y l&#237;pidos en pacientes hipertensos atendidos en Atenci&#243;n Primaria&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal de todas las historias cl&#237;nicas de pacientes hipertensos&#44; a partir de las cuales se seleccionaron los enfermos en tratamiento farmacol&#243;gico que consultaron en los 25 centros de Salud del &#193;rea 6 de Madrid&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De 92&#46;079 historias&#44; 19&#46;501 enfermos &#40;21&#44;2&#37;&#41; con hipertensi&#243;n arterial &#40;HTA&#41; ten&#237;an un diagn&#243;stico previo de ECV &#40;23&#44;9&#37; eran varones y el 19&#44;1&#37; mujeres&#41;&#46; En estos hipertensos con ECV los diagn&#243;sticos m&#225;s frecuentes y su proporci&#243;n en hombres y mujeres fueron&#58; cardiopat&#237;a isqu&#233;mica&#44; 35&#44;6&#37; &#40;43&#44;7&#47;27&#44;6&#37;&#41;&#59; fibrilaci&#243;n auricular&#44; 29&#44;5&#37; &#40;25&#47;33&#44;9&#37;&#41;&#59; ictus&#44; 24&#37; &#40;22&#47;26&#44;7&#37;&#41;&#59; insuficiencia renal&#44; 15&#44;7&#37; &#40;18&#44;2&#47;13&#44;2&#37;&#41;&#59; insuficiencia card&#237;aca&#44; 15&#44;3&#37; &#40;10&#44;4&#47;20&#44;2&#37;&#41;&#59; y enfermedad arterial perif&#233;rica&#44; 7&#44;5&#37; &#40;8&#44;7&#47;6&#44;4&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En los hombres la prescripci&#243;n de f&#225;rmacos antihipertensivos&#44; hipolipemiantes y antiagregantes fue mayor que en las mujeres&#44; y en &#233;stas predomin&#243; la prescripci&#243;n de diur&#233;ticos&#44; antagonistas de los receptores de la angiotensina y anticoagulantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; El porcentaje de hombres y mujeres con presi&#243;n arterial<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg fue del 60&#44;5 y del 59&#44;1&#37;&#44; y de LDL-colesterol &#60; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 40&#44;4 y 31&#37;&#44; respectivamente&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En los casi 20&#46;000 hipertensos analizados por enfermedad cardiovascular&#44; se observan diferencias apreciables de g&#233;nero en la prevalencia&#44; tratamiento y consecuci&#243;n de objetivos terap&#233;uticos en los diversas enfermedades cardiovasculares&#46; Estos resultados sugieren la conveniencia de homogeneizar los registros inform&#225;ticos&#44; como el presente&#44; para seguir los resultados en el tiempo&#44; sin necesidad de realizar estudios por muestras&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To examine the type of cardiovascular disease &#40;CVD&#41; and treatment and achievement of treatment goals in blood pressure and lipids in hypertensive patients in primary care&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study of all medical records of hypertensive patients&#44; from which patients with antihypertensive treatment who visited the 25 Primary Health Care Centers of the 6<span class="elsevierStyleSup">th</span> sanitary district of Madrid during 2008 were selected&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">From a total of&#160;92&#44;079 patients&#44; 19&#44;501 &#40;21 2&#37;&#41; with an arterial hypertension had a previous diagnosis of CVD &#40;23&#46;9&#37; in males and 19&#46;1&#37; in females&#41;&#46; In hypertensive with CVD&#44; the most frequent diagnosis and their proportion in males and females were&#58; ischemic heart disease 35&#46;6&#37; &#40;43&#46;7&#37;&#47;27&#46;6&#37;&#41;&#44; atrial fibrillation 29&#46;5&#37; &#40;25&#37;&#47;33&#46;9&#37;&#41;&#44; stroke 24&#37; &#40;22&#37;&#47;26&#46;7&#37;&#41;&#44; chronic renal disease 15&#46;7&#37; &#40;18&#46;2&#37;&#47;13&#46;2&#37;&#41;&#44; heart failure 15&#46;3&#37; &#40;10&#46;4&#37;&#47;20&#46;2&#37;&#41; and peripheral artery disease 7&#46;5&#37; &#40;8&#46;7&#37;&#47;6&#46;4&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46; Antihypertensive drugs&#44; lipid-lowering drugs and antiplatelet therapy were used more often by males&#44; with women predominating in the prescription of diuretics and angiotensin receptor blockers and anticoagulants&#44; &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46;The proportion of patients with blood pressure<span class="elsevierStyleHsp" style=""></span>&#60;140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg was 60&#46;5&#37; and 59&#46;1&#37;&#44; and that of LDL-cholesterol &#60;100<span class="elsevierStyleHsp" style=""></span>mg&#47; dl was 40&#46;4&#37; y 31&#37; &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;005&#41;&#44; in males and females&#44; respectively&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In almost all the 20&#44;000 patients with CVD studied&#44; substantial gender differences in the prevalence&#44; therapy and achievements of goals in the different types of CVD were observed&#46; These results suggest the convenience of homogenization of the computerized registries at the present&#44; for monitoring results over time&#44; with no need of continuous sampling-based studies&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;6 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;1 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;2 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colesterol &#40;mg&#47;dl&#41; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207&#44;6 &#40;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">211&#44;4 &#40;48&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">194 &#40;52&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL-colesterol &#40;mg&#47;dl&#41; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&#44;4 &#40;37&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&#44;2 &#40;82&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;72&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HDL-colesterol &#40;mg&#47;dl&#41; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;6 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;3 &#40;15&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;6 &#40;15&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triglic&#233;ridos &#40;mg&#47;dl&#41; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;80&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&#44;3 &#40;82&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;72&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;91 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;86 &#40;0&#44;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;07 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FGe &#40;&#60; 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PAS&#47;PAD &#60; 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL &#60; 100 mg&#47;dl &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diur&#233;ticos &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Betabloqueantes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antagonistas del calcio &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inhibidores SRAA &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipolipemiantes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antiagregantes&#47;anticoagulantes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;6&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; FGe&#58; filtraci&#243;n glomerular estimada&#59; HDL-colesterol&#58; colesterol ligado a lipoprote&#237;nas de alta densidad&#59; LDL-colesterol&#58; colesterol ligado a lipoprote&#237;nas de baja densidad&#59; PA&#58; presi&#243;n arterial&#59; PAD&#58; presi&#243;n arterial diast&#243;lica&#59; PAS&#58; presi&#243;n arterial sist&#243;lica&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presi&#243;n del pulso &#40;mmHg&#41; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">58&#44;1 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  """
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n por g&#233;nero de las diferentes enfermedades cardiovasculares en los pacientes con hipertensi&#243;n arterial</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">C&#46; isqu&#233;mica&#58; cardiopat&#237;a isqu&#233;mica&#59; F&#46; auricular&#58; fibrilaci&#243;n auricular&#59; I &#46;card&#237;aca&#58; insuficiencia card&#237;aca&#59; I&#46; renal&#58; insuficiencia renal&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mujeresn<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#46;063&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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Vol. 212. Núm. 2.
Páginas 55-62 (febrero 2012)
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39
Vol. 212. Núm. 2.
Páginas 55-62 (febrero 2012)
Original
Enfermedad cardiovascular en pacientes con hipertensión arterial: diferencias por género a partir de 100.000 historias clínicas
Cardiovascular disease in hypertension: gender differences in 100,000 clinical records
Visitas
39
T. Gijón-Condea,b,
Autor para correspondencia
gijonmt@gmail.com
teresa.gijon@uam.es

Autor para correspondencia.
, J.R. Banegasb
a Centro de Salud Universitario Cerro del Aire, Majadahonda, Madrid, España
b Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, España
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Estadísticas
Tablas (5)
Tabla 1. Características clínicas generales de los pacientes con hipertensión arterial, según presencia de enfermedad cardiovascular
Tabla 2. Características clínicas por género (hombres vs mujeres) en los pacientes con hipertensión arterial y enfermedad cardiovascular
Tabla 3. Distribución por género de las diferentes enfermedades cardiovasculares en los pacientes con hipertensión arterial
Tabla 4. Prevalencias globales y ajustadas por edad en los pacientes con hipertensión arterial y enfermedad cardiovascular
Tabla 5. Prescripción de fármacos en los pacientes con hipertensión arterial y enfermedad cardiovascular
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Resumen
Antecedentes y objetivos

Evaluar las características de la enfermedad cardiovascular (ECV), el tratamiento y cumplimiento de los objetivos terapéuticos para la presión arterial y lípidos en pacientes hipertensos atendidos en Atención Primaria.

Pacientes y métodos

Estudio transversal de todas las historias clínicas de pacientes hipertensos, a partir de las cuales se seleccionaron los enfermos en tratamiento farmacológico que consultaron en los 25 centros de Salud del Área 6 de Madrid.

Resultados

De 92.079 historias, 19.501 enfermos (21,2%) con hipertensión arterial (HTA) tenían un diagnóstico previo de ECV (23,9% eran varones y el 19,1% mujeres). En estos hipertensos con ECV los diagnósticos más frecuentes y su proporción en hombres y mujeres fueron: cardiopatía isquémica, 35,6% (43,7/27,6%); fibrilación auricular, 29,5% (25/33,9%); ictus, 24% (22/26,7%); insuficiencia renal, 15,7% (18,2/13,2%); insuficiencia cardíaca, 15,3% (10,4/20,2%); y enfermedad arterial periférica, 7,5% (8,7/6,4%) (p<0,05). En los hombres la prescripción de fármacos antihipertensivos, hipolipemiantes y antiagregantes fue mayor que en las mujeres, y en éstas predominó la prescripción de diuréticos, antagonistas de los receptores de la angiotensina y anticoagulantes (p<0,05). El porcentaje de hombres y mujeres con presión arterial<140/90mmHg fue del 60,5 y del 59,1%, y de LDL-colesterol < 100mg/dL, 40,4 y 31%, respectivamente.

Conclusiones

En los casi 20.000 hipertensos analizados por enfermedad cardiovascular, se observan diferencias apreciables de género en la prevalencia, tratamiento y consecución de objetivos terapéuticos en los diversas enfermedades cardiovasculares. Estos resultados sugieren la conveniencia de homogeneizar los registros informáticos, como el presente, para seguir los resultados en el tiempo, sin necesidad de realizar estudios por muestras.

Palabras clave:
Hipertensión arterial
Enfermedad cardiovascular
Prevalencia
Tratamiento
Objetivos terapéuticos
Diferencias de género
Abstract
Objectives

To examine the type of cardiovascular disease (CVD) and treatment and achievement of treatment goals in blood pressure and lipids in hypertensive patients in primary care.

Patients and methods

A cross-sectional study of all medical records of hypertensive patients, from which patients with antihypertensive treatment who visited the 25 Primary Health Care Centers of the 6th sanitary district of Madrid during 2008 were selected.

Results

From a total of 92,079 patients, 19,501 (21 2%) with an arterial hypertension had a previous diagnosis of CVD (23.9% in males and 19.1% in females). In hypertensive with CVD, the most frequent diagnosis and their proportion in males and females were: ischemic heart disease 35.6% (43.7%/27.6%), atrial fibrillation 29.5% (25%/33.9%), stroke 24% (22%/26.7%), chronic renal disease 15.7% (18.2%/13.2%), heart failure 15.3% (10.4%/20.2%) and peripheral artery disease 7.5% (8.7%/6.4%) (P<.05). Antihypertensive drugs, lipid-lowering drugs and antiplatelet therapy were used more often by males, with women predominating in the prescription of diuretics and angiotensin receptor blockers and anticoagulants, (P<.05).The proportion of patients with blood pressure<140/90mmHg was 60.5% and 59.1%, and that of LDL-cholesterol <100mg/ dl was 40.4% y 31% (P<.005), in males and females, respectively.

Conclusions

In almost all the 20,000 patients with CVD studied, substantial gender differences in the prevalence, therapy and achievements of goals in the different types of CVD were observed. These results suggest the convenience of homogenization of the computerized registries at the present, for monitoring results over time, with no need of continuous sampling-based studies.

Keywords:
Arterial hypertension
Cardiovascular diseases
Prevalence
Treatment
Therapeutic goals
Gender differences

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